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"...if we insisted on full-time surgeons we would have a personnel problem: Three in four of our junior doctors are female."

We have had "part time doctors" in the US for a while, not to mention a movement toward "girl specialties" (read: gyno/derm/few others). It's a significant contributor to our rising medical costs.

Supply of medical services = (# of doctors) x (average hours worked). The # of doctors is basically fixed (all medical school slots are filled, and there is no movement to build more), which means part time doctors reduce the supply of medical services. Net result: rising prices (note: not the only cause of this), fewer people being treated.

Hopefully things work out better for the dutch than for us.

I think China has a very forward thinking idea on this: if training slots are limited by government fiat, raise standards for women relative to men (since society will get fewer hours of output from a given woman, she will need a higher productivity to compensate).



We have had "part time doctors" in the US for a while, not to mention a movement toward "girl specialties" (read: gyno/derm/few others). It's a significant contributor to our rising medical costs.

Actually, an increase in the number of doctors (or, presumably doctor-hours) seems to lead to an increase in medical care costs. Adding more doctors increases the amount of medical service provided rather than providing the same amount of service at a reduced cost.


Could you provide a source? It sounds interesting, if true.

Such a result has interesting implications. Since we know the demand for medicine is not perfectly inelastic (various experiments with copays prove this), it would suggest that some external force (insurance companies?) is keeping prices down and the constraining factor is supply.


There's one article in particular that I'd like to link to, but I'm having difficulty digging it up.

If you'd like some data to play with, however:

https://www.cms.gov/NationalHealthExpendData/05_NationalHeal... http://www.census.gov/compendia/statab/2010/ranks/rank18.htm...

The former contains Medicare spending per enrollee on a per-state basis, and the latter has the number of doctors per capita.

Of the top ten states in Medicare spending per enrollee, six are in the top ten in doctors per capita.

This is all just a back of the envelope calculation, of course, but it does argue against the thesis that more doctors equals cheaper health care.


Interesting, but hardly conclusive. Two problems with the conclusion you are trying to make:

Cheaper health care != less money spent on health care. Consumers might purchase more health care even as prices come down (resulting in more money spent).

This data doesn't show the direction of causality. It could just as easily reflect doctors chasing money as it could reflect prices increasing as a result of doctors becoming available.

(Similarly, states with more illegal immigrants tend to spend more money on farm labor. Do illegal immigrants raise the prices of farm labor?)

Still, it's interesting data to see.


If you haven't already read Atul Gawande's New Yorker piece comparing medical care expenses in McAllen, TX vs El Paso, TX, then here you go:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_...

Obviously it covers more than just this particular topic, but the odd behavior of markets for health care is a central concern he addresses.


I was kind of hoping for more than just 2 data points (McAllen and El Paso). Maybe even some hard numbers.


The two towns are a framing device for the article and provide a rhetorical starting point for an investigation of various issues and trends with health care in America.

I'm pretty sure that you could skim the article and find some numbers if you wanted to.


This seems to be a basic personal economics issue - would you rather work 40+ hours a week at a job that paid X, or 20-30 hours at a job that paid X*2?

That's the rationalization a lot of professionals are making.

Similarly, if you're offering a rare/unique service that is in high demand, and that only you personally can provide, and you start to become overworked, do you raise rates? If you want time off, would it not make sense to raise rates until you have a better work/non-work time balance?


Everything you say is true for a free market in goods/services. In that case, rising prices would induce more people to become doctors, thereby increasing the supply.

Unfortunately, there is no free market in medical training - supply is artificially capped. A huge number of qualified people who want to become a doctor are turned away from medical school, and the government artificially restricts the number of medical schools (at the behest of the AMA) [1].

[1] Some numbers. I'll assume the average black medical student is qualified (but the 49'th percentile is unqualified), giving me cutoff of MCAT VR 8.3 for a "qualified doctor". This cutoff is chosen so I can call people who disagree with me a racist. Some gaussian-fu suggests we could train at least 10-15k more doctors per year.

http://web.archive.org/web/20080801022539/http://www.aamc.or...

(Unfortunately the AAMC took the numbers down, but the wayback machine is helpful.)


This is correct, but the seedier side of it is belonging to a cartel that works to legally limit the competition: http://www.nytimes.com/2010/12/23/nyregion/23caribbean.html?...




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